The present invention relates generally to the field of nutrition, more particularly to the use of probiotics in nutrition and in particular to the use of probiotics in nutrition in a pre- and/or post-surgical environment.
As early as 1907, the Russian scientist, E. Metchnikoff (1845-1919), working at the Pasteur Institute in Paris, published work showing the beneficial effects of lactic acid bacteria contained in yogurt. Metchnikoff hypothesized that a high concentration of lactobacilli in the intestinal flora might be important for health and longevity in humans (Metchnikoff E M, et al., The prolongation of life: optimistic studies. London: Heinemann 1907; 161-183).
Since this time no other group of bacteria has been proposed to be responsible for so many different beneficial effects as lactic acid bacteria, mainly lactobacilli and Bifidobacteria. These include the stimulation of macrophage phagocytosis of viable salmonella (Hatcher G et al., J. Dairy. Sci. 1993; 76:2485-2492); the enhancement of IgA production in intestinal secretions (Perdigon G, et al., J. Food. Proct. 1990; 53:404-410), production of antimicrobial substances (Shahani K M, et al., Am. J. Clin. Nutr. 1980; 33:2448-2457; Silvia M, et al., Antimicr. Agen. Chemother. 1987; 31:1231-1233); the inhibition of cell attachment and cell invasion by enterovirulent bacteria (Bernet M F, et al., Gut 1994; 35:483-489) and the reduction of intestinal permeability to macromolecules during rotavirus induced diarrhea (Isolauri E, et al., Pediatr Res 1993; 33:548-553). Lactobacillus bacteria have also been used with success in the treatment of relapsing Clostridium difficile colitis (Gorbach S L, et al., Lancet 1987; 2:1519).
These beneficial properties are not shard by all Lactobacillus and Bifidobacteria strains. Lactic acid bacteria that show a beneficial biological activity are considered to be probiotics. However, not all probiotics share the same type of beneficial biological activities. One example of a Lactobacillus strain that belongs to the group of probiotics is the Lactobacillus johnsonii (La1) organism (Nestle. Lactobacillus johnsonii (La1) Scientific Overview; 1999). This strain was isolated several years ago from the human intestinal flora at the Nestle Research Center in Lausanne.
The La1 bacteria can be considered as a probiotic because the strain is
Non-pathogenic
Remains viable on reaching the small intestine or the colon
Shows good adhesion to the intestinal mucosal membrane
Is a natural component of the human intestinal flora
In addition, research has demonstrated that La1 bacterial strain possesses some other beneficial properties including:                Inhibition of the adherence of several enteropathogenic bacteria (E Coli ssp and Salmonella spp) to human intestinal cells in vitro        Anti-diarrheal effects and inhibition of invasive E Coli species        Effect on the prevention of H. pylori-associated diseases        Stimulation of immune defenses        Stimulation of phagocytosis        Stimulation of IgA production        Antagonism of colonization by Clostridium perfringens         
The La1 bacteria strain is presently used in fermented milk specialities (Nestle LC1 product range) which are widely marketed in Europe as a new concept in healthy eating. No adverse events have been documented when used by the general population, and the La1 probiotic strain can thus be considered as safe.
The administration of probiotic bacteria in general has been hypothesized to affect the composition of the intestinal microflora with reduction of pathogens in favour of non-pathogens. These events might modulate the immune and inflammatory responses and the gut function. (Liopis, M, et al., Gut 2005 54: 955-959).
Experimental data demonstrated that the modulation of the mucosal function and enteric microflora by Lactobacillus plantarum reduces septic morbidity and mortality in animals. The administration of a mix of probiotics has been shown to be more effective than antibiotics to cure pouchitis in humans (Gionchetti, Paolo et al., Gastroenterology 2003, 124:1202-9.)
While the positive effects of probiotics as an aspect of modern nutrition today under normal living circumstances are widely accepted, the use of probiotics as a part of nutrition in a pre- and/or post clinical environment has never been suggested.
One reason for this might be that is commonly known that surgery should take place under sterile conditions. The consumption of bacteria as preparation for surgery and briefly after surgery appears to be contradictory to the recommended sterility.
Usually, and in stark contrast to healthy people under normal living conditions, people in a pre- or post clinical environment usually are under a significant amount of stress, are under heavy antibiotic treatment, might suffer from an impaired immune system and/or are at a significant danger of being colonized by pathogenic and antibiotic resistant bacteria that appear more and more often in repeatedly sterilized environments such as hospitals.
Consequently, a pre- and/or post clinical environment cannot be compared to normal living circumstances.
Since, however, patients undergoing surgery have a high risk of developing infections, e.g., due to intraoperative contamination with enteral contents and the occurrence of bacterial translocation, it would be desirable to have available a method that allows to prevent and/or to reduce of such complications and post operative sepsis.